Anthem Coding Jobs in Ohio (NOW HIRING)

Reports to: Waiver Service Coordinator Supervisor

FLSA Status: Exempt

Dedicate yourself to an Organization and Mission you can be proud of by joining the Western Reserve Area Agency on Aging!

Our Mission:

We provide choices for people to live independently in the place they want to call home.

About Us:

Western Reserve Area Agency on Aging (WRAAA) is a private non-profit corporation, organized and designated by the State of Ohio to be the planning, coordinating and administrative agency for federal and state aging programs in Cuyahoga, Geauga, Lake, Lorain and Medina Counties. It is one of twelve Area Agencies on Aging (AAAs) in the state organized together with local service provider organizations and the Ohio Department of Aging (ODA) to form the state's public aging services network. The network works together to create opportunities for Ohioan's to receive needed home and community services and supports; and to age successfully in their own homes and communities.

Candidates we love…

• Self-motivated and compassionate Social Workers (LSWs) and Registered Nurses (RNs) looking to be part of a Best-in Class organization
• Team players who are committed to providing superior service to all they serve
• Enthusiastic professionals excited to grow with an organization that values dedication, innovation and collaboration.

What our staff loves about us…

• A generous six-week PTO program and thirteen paid holidays
• A $750.00 investment in professional development through a substantial, annual training funds allotment
• A 401K program with company match
• Paid parking in a covered parking garage
• Medical, Dental, Vision Benefits and so much more…

Position Summary: The MyCare Ohio, Anthem - Waiver Service Coordinator is responsible for the coordination of all services and the authorization of all waiver services for assigned members enrolled in community-based waiver programs. Social Worker (LSW) or Registered Nurse (RN) licenses are required. At least one year of experience working with individuals with physical and/or behavioral disabilities in a home health care, medical social work, or behavioral health environment is required.

Job Duties:

• Evaluate assessment and care management data to determine ongoing care needs and service options.
• Complete initial MyCare Ohio assessment, annual and event-based assessment process (if applicable to MCO plan).
• Complete enrollment process of eligible consumers into the appropriate program (if applicable).
• Develop and implement a waiver services care plan for members and collaborate with Assisted Living Facility staff to develop and implement a waiver services care plan for all AL enrollees as appropriate. Waiver Service Plans include interventions to address a consumer’s unstable conditions
• Collaborate with the Departments of Job and Family Service to establish and/or maintain Medicaid eligibility.
• Monitor and evaluate the waiver services care plan, service quality and program eligibility.
• Provide education and support to consumers and their caregivers.
• Advocate on behalf of members and/or caregiver/family and assist individuals in securing appropriate services and care settings in collaboration with MCO Care Managers and providers of service(s)
• Transition dual eligible consumers into MyCare Ohio as appropriate
• Collaboration with the managed care plan Care Manager for approval especially in regard to Minor Home Modifications and Durable Medical Equipment.  
• Manage the acquisition of provider bids, MD prescriptions and Physical Therapy evaluations as needed.  Authorize repairs and/or equipment as appropriate.
• Disenroll all ineligible consumers from the waiver program as appropriate.
• Apply judgments and perform clinical practice based upon education, experience and professional practice standards.
• Maintain minimum proficiency in all requisite computer applications and software.
• Maintain consumer confidentiality according to agency policy.
• Report abuse, neglect, or exploitation of older adults as a mandated reporter as required by Ohio law.
• Abide by the professional code of ethics established by licensure.
• Participate in trainings, meetings, in-services and continuing education opportunities; also participate in MyCare Ohio trainings and meetings as requested by supervisor, manager or assigned Managed Care Plan.
• Meet time frames for timely and accurate completion of documentation.
• Ability and willingness to travel to community and consumer locations within our five county service areas (Cuyahoga, Lorain, Geauga, Lake and Medina counties).
• Perform other duties as assigned by supervisor as needed to meet agency goals.
• This position's primary duty is to perform work directly related to the successful operation of the Agency.  Accordingly, the employee must exercise discretion and independent judgment with respect to matters of significance.
• All staff have the responsibility and authority to propose ways to improve quality and to fully participate in quality improvement efforts.

• Current licensure as a Social Worker by the State of Ohio Counselor and Social Work Board, or as a Registered Nurse with the Ohio Board of Nursing.
• At least one year of experience working with individuals with physical and/or behavioral disabilities in a home health care, medical social work, or behavioral health environment is required.
• Excellent verbal and written interviewing and assessment skills.
• Basic knowledge of major chronic disabling illnesses for people of all ages, disease processes, and normal aging or special knowledge in pediatrics and young adults.
• Ability to effectively communicate with the disabled and elderly populations and general public, both in person and by phone.
• Ability to communicate in a collaborative, effective manner with others and to maintain good working relationships.
• Ability to comprehend written material related to essential job functions.
• Ability to comprehend basic medical terminology.
• Knowledge of local resources for older adults and people with disabilities.
• Ability to comprehend, recall, and apply facts related to essential job functions.
• Ability to analyze, evaluate, and implement a reasonable course of action based on available information.
• Ability to detect specific odors related to the assessment of a client’s health/hygiene and the safety of the client’s environment.
• Ability to ambulate enough to access private homes/locations which may not be readily accessible.
• Must have basic computer skills, including Microsoft Office applications.
• Ability to use and transport a laptop computer and case, therefore, must be able to lift/carry a minimum of twenty (20) pounds.
• Must have a car available during working hours, as well as the ability to legally drive a car.

Physical Requirements:

• May sit, stand, stoop, bend, and ambulate intermittently during the day.
• May need to sit or stand for extended periods.
• See in the normal visual range with or without correction.
• Hear in the normal audio range with or without correction.
• Finger dexterity to operate office equipment required.
• Ability to communicate in face to face, phone, email, and other communications.
• Ability to push/pull/lift/20 pounds.
• Requires some exposure to warm chemicals and cleaning products.
• Requires exposures to warm and cold temperatures.

If you are interested in joining our team of professionals, please complete the application and upload your resume and a cover letter. We look forward to hearing from you! 

The Agency is committed to providing equal employment and advancement opportunities to all. Employment decisions are made based on each person’s performance, qualifications, and abilities. The Agency does not discriminate in employment opportunities or practices on the basis of race, color, religion, gender, sex, national origin, age, disability status, health status, genetic information or ancestry, protected veteran status, sexual orientation, gender identity or expression, or any other protected characteristic.

Western Reserve Area Agency on Aging’s Equal Employment Opportunity policy covers all aspects of employment practices, including selection, job assignment, compensation, discipline, termination, and access to benefits and training.